The symposium on human breath was organized by the Academy of Medicine Specialties of Nigeria, [AMSN] Dental Section as part of her objective of enhancing the well-being of Nigerians and others through the promotion of medical education and research, medical care and public health.  The hybrid meeting was chaired by the Chairman Board of Trustees, The Olorogun (Dr) Sonny Folorunsho Kuku supported by the President of the Academy, Prof. Oladapo Adenrele Ashiru and the Chairman, Dental Section of the Academy, Prof. Onatolu Odukoya. The Provost, College of Medicine, University of Lagos, Prof Wale Oke and the Chief Medical Director of Lagos University Teaching Hospital, Prof. Wasiu Lanre Adeyemo, who are both Fellows of the Academy, were also in attendance.

Four guest speakers of different academic, clinical and research backgrounds participated in the 3-hour program.

SPEAKER 1

The discussion was led by Professor Foluso Owotade of Department of Oral Medicine and Oral Pathology, Obafemi Awolowo University Ile-Ife, who made a very lucid and detailed presentation on an overview of human breath, tracing it to the time of Hippocrates when breath gas was linked to diseases. The speaker also took the audience through the clinical and research ramifications of human breath, which he described as a very dynamic process.  He also took a cursory look at the properties of human breath and emphasized that exchange of substances with blood takes place in the alveolar air and not the dead space where no exchange takes place with the blood stream. The composition of mid expired breath and the end tidal breath which reflects the identities and volatile organic compounds present in the blood was x-rayed. Components of exhaled breath including volatile organic compounds (both endogenous and exogenous) and respiratory droplets including proteins, viral particles, drug and non-volatile metabolites were highlighted. The evolving field of studying the volatile organic compounds in breath called “breathomics” reveals the current status of human cells, tissues and the microbiome. The molecules or their metabolites present in the exhaled air come via the skin (exposome), ingested foods/ beverages (metabolome), foreign cells (microbiome) or through the mouth, sinuses, airway or gastrointestinal tract (human metabolome). He also discussed the various mechanisms of detecting breath molecules which include spectroscopy, mass spectrometry, electrochemistry, chromatography with different levels of sensitivity and specificity. Gas chromatography with mass -spectroscopy [GC-MS] is often used because of its high sensitivity.He provided historical challenges and modern solutions to breath sampling techniques. Prof Owotade concluded that there are future prospects for human breath research especially in breath markers to detect cancer in the head and neck region where lesions are in less accessible areas but breath testing can help with early diagnosis.

SPEAKER 2.

Dr Olufemi Oyetola of the Department of Oral Medicine and Oral Pathology, Obafemi Awolowo University Ile-Ife, in his own contribution to the symposium focused on ‘Bad breath: the past, present and the future.  He extensively discussed the epidemiology of bad breath (halitosis) usually caused by volatile sulfur compounds [VSCs] with empirical data. He pointed out that sterile breath never exists and it is only good if it is socially acceptable. It is a reflection and mark of the individual’s personality. Data on the effect of bad breath and its social relationship in the population were provided. About 85% of bad breath are caused by oral health problems while the rest (15%) are outside the oral cavity. He discussed the factors responsible for qualitative and quantitative changes in exhaled air. He also reported that human breath varies with physiological factors like anxiety, depression, stress and some personality traits. He talked on odoriferous gases in breath including sulphur and non-sulphur containing compounds. He delved into organoleptic method of detecting halitosis’ (bad breath) and its limitations (low validity and difficulty in calibrating examiners etc). He looked at the traditional beliefs associated with bad breath. He reported on use of Halimeter® that was introduced in 1990 as gold standard and other methods including gas chromatography, mass spectrometer and colometer in the present-day management of bad breath. Issues discussed bothered on subjects’ and examiners’ calibration in breath measurements, including indirect methods such as BANA test, saliva incubation test, PCR of oral bacteria, Ninhydrin test, Beathron.  He found that most of our population still lacked proper dental awareness. He anchored on the fact that artificial intelligence [AI] and olfactory technology hold a viable potential for breath medicine in the future.

SPEAKER 3.

Prof. Joanne Lusher of Regent’s University. who could not give a formal presentation online because of technical glitches, made her materials available.

In her contribution, she looked at the BioPsychoSocial model and its application to oral malodour. She emphasized the theoretical foundation of the model which incorporates all areas of health psychology that interact with biological, psychological and social influences of bad breath.  The biological factors include genetic predisposition of individual, psychological behaviours which include coping skills, stress and personality type, while sociocultural factors include eating habits, exercise, drinking/smoking lifestyle. She also emphasized the adoption of a multidisciplinary, multi-component and holistic interactive approach to oral malodour. Some of this interactive chain includes anxiety, depression, confidence, self-esteem, relationships, social isolation, happiness, health behaviours, suicide ideation, pain/management, medication, quality of life, stress/nervousness bullying personality, panic attacks, addictions, social withdrawal, avoidant behaviours and coping strategies.  She concluded that this model raises important questions for practice which include multidisciplinary care planning, support for whole person and multiple components working together to reach oral health and outcomes directly or indirectly.

SPEAKER 4.

Finally, Dr Olaide Koleoso, Deputy Director of Clinical Psychology at University of   Benin Teaching Hospital, Benin city discussed the ‘Social aspects of Human Breath’ which is an important aspect of social norms, perceptions and communication dynamics. Bad breath is seen as a major and one of the oldest social problems. He reported that bad mouth odour (halitosis) cuts across socio-demographics with more than 50% of the population suffering from this social malady and one in ten adults afflicted with a severe condition that requires medical assistance. It is indeed a social life killer to sufferers. He further classified oral malodour into 3 different groups of distinct characteristics; genuine, pseudo- and delusional halitosis. Dr Koleoso analyzed the implications of social and emotional impact of halitosis including communication challenges, marital disharmony and partner rejection, negative perceptions and judgment and other interpersonal dynamics leading to high disposition to anxiety, discomfort, nervousness, feeling of anger, low self-esteem and social distancing. Cultural and religious norms with their attendant expectations were found to be significantly associated with breath odour and oral hygiene practices.

He concluded that the psycho-social impact is the ‘end point’ of human breath. It is therefore important to approach the issue of breath odour with sensitivity and empathy because of the direct effect on quality of life.

 

CLOSURE OF SYMPOSIUM

After a closing remark in which the chairman of the occasion, Olorogun S.F. Kuku commented positively on the successful outcome of the symposiunm, the event was bro

ught to a close.

VOTE OF THANKS

Prof. Rafael Adebola, coordin

ator of the Local Organising Committee for the Symposium, gave a vote of thanks.

 

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